KR20140069254A - Illuminated and modular soft tissue retractor - Google Patents

Abstract

A surgical retractor that illuminates the surgical area includes an ergonomic handle, a retractor blade coupled to the handle, a quick release mechanism, and an illuminator blade. The retractor blade is adjusted to pick up tissue to pull tissue, and the quick release mechanism is adjusted to engage the handle with the retractor blade. The illuminator blade functions as a waveguide that transmits light by total internal reflection. Light is extracted from the fixture to illuminate the surgical area. The retractor blade is releasable from the handle without the need to separate the illuminator blade from the handle and without the need for optical separation of the illuminator blade from the light source. The retractor can also be adjusted to vent smoke from the surgical area.

Description

TECHNICAL FIELD [0001] The present invention relates to an illuminated modular soft tissue retractor,

(Cross reference)

This application is not a provisional application and claims the benefit of U.S. Provisional Patent Application No. 61 / 538,675, filed September 23, 2011 (Attorney Docket No. 40556-723.101), the entire contents of which are incorporated herein by reference .

This application is related to U.S. Patent Application No. 11 / 654,874; 11 / 432,898; 11 / 818,090; 12 / 750,581; 11 / 805,682; 11 / 923,483; 12 / 191,164; 13 / 026,910; And 13 / 253,785, the entire contents of each of which are incorporated herein by reference.

The present invention relates generally to medical devices and methods, and more particularly to illuminated medical devices and methods.

Illumination of the body cavity for diagnosis and / or treatment is generally provided by illumination on the head or by a headlight. These types of lighting may be difficult to use in certain situations. For example, overhead lighting should be adjusted continuously as well as to illuminate the different parts of the surgical site as well as the physician's position with respect to the patient. Also, the overhead lighting device needs to be attached to the sterilizer handle so that the doctor can make adjustments without violating the sterilization zone. Even in that case, the light supplied by the overhead lamp may not sufficiently illuminate the working space. Headlamps can be heavy and inconvenient to use, which may require an assistant to help the doctor wear headlamps on top of them, and they usually generate significant amounts of heat during use time, which limits additional convenience, A fire may occur if handled. The headlamps also always require the physician to adjust the head position continuously to illuminate the working area, which may be inconvenient to the physician.

In an attempt to address some of these problems, surgical instruments, such as these retractors, have been used to illuminate a surgical area with a light pipe, such as an optical fiber, to conduct light from a light source such as halogen light or an LED light source . For example, some retractors of conventional lighted soft tissues utilize a fiber bundle attached to a retractor handle. Fiber bundles provide highly focused light with a significant amount of heat. The fiber optic tube is generally within the user's line of sight, thereby interfering with the physician's vision in use. The fiber bundle should also be tuned to provide only a narrow point of light and subsequently illuminate the surgical site and minimize glare and shadows. Also, optical fiber bundles require precision machining and polishing, and optical fibers are fragile and easily scratched, occluded by blood or other debris, or damaged during use. Thus, the optical fiber bundle may also have problems when used in an illuminated surgical system.

Some materials that overcome some of the problems associated with fiber bundles can be used as waveguides. Typical materials such as, for example, acrylics and polycarbonates have also been used as waveguides, but these materials have unstable light transmission properties for extended use and their transmission properties can be changed after sterilization using conventional techniques. For example, a plurality of polymers cross-link, become yellow, or brittle after final sterilization of radiation. Heat in autoclave treatment or ethylene oxide sterilization can modify the waveguide. Precision optical polymers also have limited mechanical properties that limit their use in medical and surgical operations. For example, some polymers are brittle and can be easily pulverized during use, or difficult to process during manufacture (e.g., which can hardly be injection molded).

In addition to some of the problems of illumination in the surgical area, surgical instruments such as retractor blades do not always accommodate the structure to be treated, and the handle is not ergonomically shaped to make the operator comfortable at various locations. Conventional retractors may also interfere with the electrosurgical device and may result in unwanted electrical arcing. In addition, smoke or other fumes generated during electrosurgery are toxic and / or can cause discomfort and mental discomfort to the physician. Current ventilation systems can interfere with the annoying or visualization of the surgical procedure.

It would therefore be desirable to provide an improved illuminated medical device that provides better illumination to the workspace and reduces or eliminates some of the weight and thermal constraints of conventional headlights and overhead lighting. Such a device can release toxic gases produced by the electrosurgical device while maintaining a very low profile to prevent interference with the electrosurgical device and to avoid visualizing smoke and surgical procedures. Such a device preferably provides excellent illumination that allows visualization of the surgical area including adjacent tissues such as nerves or blood vessels. It is also desirable to provide an improved illuminated medical device that also has the desired mechanical properties in service, ease of manufacture (e.g., can be injection molded without the need for optical polishing), sterilization, and service. It is also desirable to provide an illuminated medical device that is economically designed for operator convenience and that can be easily adjusted or altered using different structures and other attachments that accommodate the position of the operator. Such devices preferably include attachments such as retractable blades that can accommodate a variety of waveguide lighting fixtures and interchangeable handles. It would also be desirable to replace the retractor blades and handles that have an easily actuated release mechanism that facilitates stable interoperability with minimal operator effort, generally in a slippery condition that occurs in surgery. Such a device has a low profile that can be placed in a small surgical area that fits through a small incision or reduces scar formation, improves healing time, and reduces hospitalization time. At least some of these purposes are handled in accordance with the embodiments disclosed herein.

The present invention relates generally to medical devices and methods, and more particularly to illuminated medical devices and methods. Such a device is preferably modular and may be replaced by other handles and blades and may have other features, such as a flue gas function.

In a first embodiment, an illuminated modular surgical retractor for illuminating a surgical area comprises a handle designed to be ergonomically fit to the physician's hand, a retractor blade releasably coupled to the handle, And an illuminator blade releasably coupled to the handle and disposed adjacent the retractor blade. The retractor blade is adjusted to pick up tissue and pull the tissue in the traction direction, and the quick release mechanism is adjusted to engage the handle with the retractor blade. The illuminator blade includes a light input portion, a light conducting portion, and an optical output portion, and functions as a waveguide that transmits the light from the optical input portion to the optical output portion through the optical delivery portion by total internal reflection. Light is extracted from the light output section to illuminate the surgical area. The retractor blade is releasable from the handle in a direction transverse to the traction direction and without the need to separate the fixture blade from the handle. The retractor blade is also releasable from the handle without the need for optical separation of the illuminator blade from the light source. The light source may be an external light source such as halogen light, or the light source may be an LED that may be coupled to or integrated with the handle. A rechargeable or disposable battery may be disposed in the handle for powering the light source. The light source may also be programmable to provide different illumination.

The handle has a proximal end and a distal end, and the handle may further comprise a flared area adjacent the near end to facilitate handling by a physician. The handle may also include other ergonomic features such as a wavy scalloped area adjacent to the proximal end, a hub or textured handle disposed releasably coupled to the proximal end of the handle, And may include an outer surface. The texturizing surface may include a plurality of finger gloves disposed circumferentially about the handle so that the surgeon can easily handle the handle. The handle may comprise a substantially cylindrical body and may have a first channel extending between its proximal and distal ends sized to receive the cable to optically couple the light input of the illuminator blade to the light source. The handle may include a plurality of cable positioning apertures disposed adjacent a proximal end of the handle and the aperture is sized to slideably receive the cable to optically couple the illuminator blade with the light source. Lt; / RTI > The handle may also include a second channel extending between the proximal and distal ends of the handle and sized to receive the suction tube coupled to the retractor blade in fluid communication with the vacuum source. The cable positioning aperture communicates with the first channel and positions the cable laterally to the side of the handle. The retractor blade may be pivotably coupled to the handle. The handles may also be of any suitable mechanical and / or mechanical nature that are joined together by a different proximal end, distal end, or intermediate portion so that they fit ergonomically into the hands of the operator and have an appropriate length and shape to fit the anatomy to be treated, Thereby forming a custom handle having an electrical element.

The retractor blade may be formed of a metal such as stainless steel or aluminum, or it may be injection molded into a polymer or composite material. The blade may include a plurality of vacuum channels disposed along the blade, the handle being sized to receive a vacuum source and a suction tube coupling the plurality of vacuum channels in fluid communication, and between the proximal and distal ends thereof And a second channel extending therefrom. The retractor blade may include at least one vacuum channel disposed therein. The fixture blade is disposed in the channel of the retractor blade and can be airtightly engaged with the retractor blade to prevent vacuum leakage along the seal. The retractor blade may include one or more channels therein for delivering vacuum, and the cover is disposed thereon when hermetically engaged. The cover may be slidably engaged with the retractor blade and fixedly coupled thereto. The retractor blade may have a constant cross-sectional geometry, or it may vary from near-end to distal. For example, the thickness may decrease toward the distal end, increase in width, or decrease toward the distal end. The retractor may have a channel to receive the fixture blade and the channel depth may decrease until the channel disappears and becomes coplanar with the retractor blade surface on the distal end of the retractor blade.

The blade of the illuminator may be an optical waveguide that transmits light by total internal reflection. The optical waveguide can be injection molded and thus can be formed into a single integral component made of a single homogeneous material, such as, for example, polycarbonate, polymethyl methacrylate, cycloolefin polymer or cycloolefin copolymer, Lt; / RTI >

The retractor blade may include a distal tip that is releasably coupled to the distal end of the retractor blade and adapted to grip the tissue during traction. The retractor blade may include an extension blade releasably coupled to a distal end of the retractor blade. The distal tip may include a textured surface and may be curved upward in the traction direction. The distal tip includes a covering disposed thereon, and the coating may have a textured surface adapted to grip and grab tissue during traction. The retractor blade may include an alignment feature disposed on the retractor blade or the handle, wherein the alignment feature is adapted to linearly align the retractor blade to the handle during engagement between the retractor blade and the handle. The alignment feature may include a rail disposed on the retractor blade or the handle. Wherein the retractor blade includes a proximal region and a distal region, the proximal region is disposed in a first plane substantially parallel to the handle, and the second region is in a second plane transverse to the first plane. A portion of the retractor blade is electrically insulated.

The quick release mechanism includes an engagement element disposed on either the handle or the retractor blade and the mechanism may also have a receptacle on the other of the handle or the retractor blade. The receptacle may be sized to receive the engagement element. The engagement element may be slidably received in the receptacle, or may be rotatably engaged with the receptacle. The engagement element may include a T-shaped bar rotatably engageable with the receptacle, or it may include an enlarged head, and the receptacle may include a flange portion sized to receive the enlarged head. The quick release mechanism may include an actuator mechanism that slides or moves the engagement element between the engaged position and the disengaged position. The engagement or disengagement position may include a switch or lever or other actuation mechanism to pull or advance to the position. In the forward position, the engagement element may engage the receptacle. The engagement element may be biased to return to the traction position. The quick release mechanism may include a detent on either the handle or the retractor blade and the mechanisms may include an outlet for receiving the detent on the other of the handle or the retractor blade. The quick release mechanism may further include a locking mechanism that locks the quick release mechanism to prevent disengagement of the retractor blade from the handle. The locking mechanism may have a rotatable cam having a first position and a second position. In the first position, the rotatable cam prevents movement of the quick release mechanism to prevent disengagement of the retractor blade from the handle, and in the second position, the rotatable cam causes the operation of the quick release mechanism To permit disengagement of the retractor blade from the handle. The quick release mechanism may include a rotatable lever disposed in one of the handle or the retractor blade, and the rotatable lever may have a first position and a second position. In a first position, the lever prevents slidable movement between the retractor blade and the handle, and in a second position, the lever allows a slidable movement between the retractor blade and the handle. The surgical retractor may further include a suction tube in fluid communication with the retractor blade, the quick release mechanism may include an aperture disposed in the retractor blade to receive the suction tube.

The retractor blade may include a channel extending from its proximal end toward its distal end, and the illuminator blade may be disposed in the channel. The illuminator blade may have an active zone and a dead zone. Light passes through the active zone by the total internal reflection, and light does not pass through the dead zone by virtue of total internal reflection. The fixture blade may include an engagement element in the dead zone that causes the fixture blade to be positioned opposite the retractor blade while maintaining an air gap between the fixture blade and the active zone of the retractor blade. The light input portion of the illuminator blade may also have an active zone and a dead zone. Light passes through the active zone by total internal reflection, and light does not pass through the dead zone substantially by the total internal reflection. The light input portion may include a cylindrical proximal end adapted to be coupled with a light source and a rectangular distal end optically coupled to the photoconductive portion. A shield having a collar may be disposed over the cylindrical proximal end to maintain an air gap therebetween. The shield may be disposed on the light delivery portion. The shield preferably shields the blade illuminator from damage caused by other surgical instruments in the surgical area and also preferably shields the doctor from the flash emitted from the blade illuminator. The shield may include a tab adapted to releasably couple the blade illuminator to the handle. The light output portion may have a plurality of surface features that extract light from the blade illuminator and direct the extracted light in a lateral and / or circular direction toward the surgical area. Some of the surface features may have a parallel prism shape with a first facet and a second facet. The optical input portion may have a generally cylindrical input area that varies with a generally rectangular neck. The blade illuminator may have a width and a thickness, and the width may be greater than the thickness as a whole. The light input portion may be disposed in a plane substantially parallel to the handle, and the light output portion may be in a plane transverse to the light input portion. The surgical retractor may further include an optical input cable optically and releasably coupled to the optical input of the blade illuminator. The optical input cable optically couples the light source and the blade illuminator.

The surgical retractor may further include a vacuum channel for discharging smoke from the surgical area. The vacuum channel may include a plurality of channels disposed in the retractor blade in fluid communication with the vacuum source. A first cover or vane that can be incorporated into the waveguide may be disposed on the channels to form a plenum therebetween to deliver the smoke while maintaining a minimum profile. A second cover or wing may be disposed on the channels. The first cover may be arranged in a row with the first cover, or may be disposed on the top of the second cover, or the two covers may have joints connecting them together. The first cover or the second cover is slidable linearly with respect to the channels, so that the vacuum intensity can be adjusted. The first cover may include a plurality of apertures extending therethrough and the second cover may be adjusted such that the vacuum intensity is caused by sliding the second cover relative to the first cover to adjust exposure of the upper aperture The first cover may be slidably disposed on the first cover. The retractor blade may include a long, thin channel, and the first and second covers may be disposed in the channel. The first and second covers may be slidably disposed in a slot of the retractor blade. A vacuum hose may be disposed in the handle, which may be coupled to the retractor blade such that the vacuum hose is in fluid communication with the plurality of channels with the vacuum source. The vacuum hose may need to be disengaged from the retractor blade prior to disengagement from the handle of the retractor blade. The surgical instrument may also include a pivot mechanism coupled to the handle. The pivoting mechanism allows adjustment of the angle between the retractor blade and the handle.

In another aspect of the invention, a surgical method for traction of soft tissue includes providing an illuminator blade coupled to a handle to a handle, selecting the retractor blade from a plurality of retractor blades, And releasably coupling the first and second components. The method also includes the steps of disposing the retractor blade in a surgical area, illuminating the surgical area with light extracted from the light output portion of the illuminator blade, wherein light is emitted from the near end of the illuminator blade And releasing the retractor blade from the handle in a direction transverse to the traction direction. The retractor blade is released from the handle without having to disconnect the illuminator blade from the handle and the retractor blade is released from the handle without having to optically decouple the illuminator blade from the light source.

The step of releasing the retractor blade includes activating the actuator mechanism, releasing the detent mechanism, rotating the lever, or disengaging the retractor blade in the direction toward the distal end of the retractor blade . The cable optically couples the light source with the blade illuminator, and releasing the retractor blade from the handle does not require decoupling the cable from the blade illuminator. The retractor blade may also be released from the handle by rotating the retractor blade about the handle. The suction tube may be detached from the retractor blade and pulled through the handle to release the retractor blade from the handle. The step of engaging the retractor blade with the handle may include sliding the magnifying head into the receptacle, wherein the magnifying head may be disposed on the retractor blade or the handle, And is disposed on another of the handles. The method may further comprise locking the retractor blade and the handle after engagement between the handle and the retractor blade or unlocking the retractor blade from the handle before releasing the retractor blade and the handle have.

The method may also include releasably coupling the hub and the proximal end of the handle. Another aspect of the method may include pivoting the retractor blade relative to the handle and discharging the smoke from the surgical area. The smoke may be expelled from the surgical area by applying suction through a plurality of channels in the retractor blade. The suction strength can be adjusted by moving the plate over the plurality of channels to control its exposure. The method may also include combining or separating the distal retractor tip with the retractor blade. A cover may be applied to the distal end of the retractor blade, and the cover may have a surface feature adapted to grip tissue. The cable can be laterally disposed on one side of the handle by placing the cable in one of a plurality of cable positioning apertures disposed adjacent a proximal end of the handle.

These and other aspects and advantages of the present invention are apparent from the following description and the accompanying drawings.

(Integration by reference)

All patents, patent applications, and patent applications mentioned in this specification are herein incorporated by reference to the same disclosure as if each individual disclosure, patent or patent application were specifically and individually indicated to be incorporated by reference. It is incorporated in the text.

The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be gained with reference to the following detailed description which sets forth illustrative embodiments.
Figure 1 shows a perspective view of a soft tissue retractor.
2 shows a perspective view of the handle.
Figure 3 shows a cross section of the handle.
Figures 4A-4B show another cross-section of the handle.
5 shows a perspective view of a near-end of the handle.
Figures 6a-6c illustrate the adjustment of the retractor blade to the handle.
Figure 7a is a perspective view of a retractor blade that allows adjustment of the toe and toe out.
Figure 7b is a side view of the retractor blade of Figure 7a.
7C shows the retractor of Fig. 7A coupled to the handle and having an illumination blade device.
Figure 8a shows a side view of a surgical retractor.
Figure 8b shows a cross-sectional view of the surgical retractor in Figure 8a.
Figure 9 shows a perspective view of the retractor blade.
Figures 10a-10b show a cover disposed on the distal tip of the retractor blade.
Figure 10c shows the teeth on the distal tip of the retractor blade.
11A-11E illustrate the attachment of an illuminator blade to a retractor blade and a handle.
Figures 11F-11G illustrate various fixture blades.
Figure 12a is a perspective view of an illuminated retractor blade.
12B is an exploded view of the illuminator retractor blade input color and illuminator bulldraft input in FIG. 12A.
Figure 12C is a cross-sectional view of the illuminator blade and retractor blade of Figure 12A.
12D is a side view of the fixture blade in Fig. 12A.
Figure 12E is a front view of the fixture blade in Figure 12A.
Figures 13a-13j illustrate a retractor blade having channels for flushing.
13k-13m illustrate an alternative embodiment of a vane used for suction control.
14A-14B show flue gas using a retractor with a channel.
15A-15B illustrate an exemplary embodiment of an engagement mechanism for engaging a handle to a retractor blade.
16A-16D illustrate another exemplary embodiment of an engagement mechanism for coupling a handle to a retractor blade.
17A-17B show a locking mechanism.
Figures 18a-18f illustrate another exemplary embodiment of an engagement mechanism for coupling a handle to a retractor blade.
19A-19B illustrate an alignment feature that assists in engaging the handle with the retractor blade.
Figure 20 illustrates another exemplary embodiment of an engagement mechanism for engaging a handle to a retractor blade.
Figures 21a-21c illustrate coupling the handle to the retractor blade using the engagement mechanism in Figure 20;
Figures 22A-22B illustrate another exemplary method of coupling the retractor blade and handle together using the engagement mechanism of Figure 20;
Figures 23A-23E illustrate using the mechanism of Figure 20 to disengage and reengage the retractor blade and handle.
24A-24E illustrate exemplary use of an illuminated surgical retractor for towing tissue, illuminating a surgical area, and evacuating smoke.
Figure 25 is a perspective view of yet another illuminated soft tissue retractor.
Figure 26 is a perspective view of the illuminated soft tissue retractor shown in Figure 25;
Figure 27 is an exploded perspective view of the illuminated soft tissue retractor of Figure 25;
28 is a side view of the illuminated soft tissue retractor of Fig. 25;
29 is a cross-sectional view of the illuminated soft tissue retractor of Fig.
30 is an exploded side view of the illumination waveguide assembly of FIG.
Figure 31 illustrates the use of the retractor of Figure 25 for traction of tissue.
32A-32B illustrate an alternative embodiment of an illuminated retractor with a releasable blade.
33 shows another exemplary embodiment of an illuminated retractor with releasable blades.
34 illustrates an exemplary embodiment of a suction channel in a retractor blade.
35A-35D illustrate another exemplary embodiment of a suction channel in a retractor blade.

Modular Soft tissue Retractor

Figure 1 shows a perspective view of a soft tissue retractor 10. Retractor 10 is used to pull tissue during breast surgery or thyroid surgery on handle 14 and handle 14. A variety of retractor blades 12 may be combined with handle 14 to accommodate various situations, including different tissue, dissection, or surgical locations. The soft tissue retractor may also include any of the illumination elements for illuminating the surgical area, a suction device for evacuating smoke or other noxious fumes, and other features disclosed herein. Any of the components of the soft tissue retractor (e.g., retractor blades, handles, blade lighting devices, etc.) may be discarded as a single use, or the components may be easily cleaned or resterilized for multiple uses.

handle

The handle 14 may be a monolithic integrated structure or the handle may be secured together using techniques known to those skilled in the art such as by welding, using a locking device such as a screw, adhesive bonding, press fit fitting, And may have a plurality of modular parts to be combined. In other embodiments, the handles include modular portions that the surgeon or operator selects based on preference, and then the modular portions are releasably coupled together. For example, FIG. 2 illustrates an exemplary embodiment of a modular handle having an adjacent hub section 18 and a distal section 28. The geometry of the various hub and end sections may be provided. In the exemplary embodiment, the near-end hub section 18 is preferably sized and sized to fit comfortably in the operator's hand, and when pulled in the near-end direction, the handle is firmly held and the handle is slid off the operator's hand And a generally cylindrical body 30 having a proximal end 20 with a flared shape to aid in preventing the dislocation. Other handle shapes having an elliptical cross-section or a flat surface are also contemplated. The scallops 22 on the proximal end of the hub section 18 further assist the operator in gripping the handle. The finger glove 16 may be disposed on the outer surface of either or both of the near-end hub section 18 and the distal section 28. In a preferred embodiment, the finger glove 16 is a glove disposed circumferentially around the handle. The handle may also have a thumb grip. The handle may also have a central channel 24, partially or entirely extending between the proximal and distal ends of the handle. The center channel allows cables or other tubing to pass through the center channel to prevent the cable or tubing from being damaged, entangled, or impeding the surgical procedure being performed. The center channel 24 is open to the open channel 26 adjacent the end of the handle to permit engagement with the illumination blade, as described below. The distal section 28 may also have a cylindrical body sized to fit in the operator's hand. In an alternative embodiment, the hub section 18 and the distal section 28 are fabricated separately and then secured together. The handle may be made of a metal such as stainless steel, a cast, or may be injection molded with a polymer. Some of the handles may be synthetic materials or may include ceramics. The handle may be resterilized using ethylene oxide, gamma or electron beam irradiation, plasma, or autoclave sterilization. The handle may then also be single-use and single-use.

3 shows a cross-sectional view of a handle 14 that emphasizes a center channel 24 extending through a center channel. 4A shows a cross-sectional view of an alternative embodiment of a handle 14 having a second channel 42 and a center channel 24 at the wall of the handle and extending through the handle from the near end to the end of the handle. The second channel 42 may be used with other cables, tubes, wires, etc., which may be required in a surgical retractor. In a preferred embodiment, the second channel 42 is also connected to a vacuum tube (also referred to herein as a suction tube or vacuum line) that can be combined with a gun-like blade to provide suction for discharging harmful fumes or smoke, . Skilled artisans will appreciate that the features of any of the handles disclosed herein may be used in combination with one another. A fiber optic cable may also be disposed in the second channel to transmit light from the light source to the illumination blade apparatus. Multiple channels at the wall may also be used to connect the channels 42a and 42b such that suction tubes, optical fibers, electrical wires, or fiber optic cables are disposed in the channels 42a and suction lines are disposed in the channels 42, It is intended for other cables that can be used as in 4b.

Figure 5 shows the near end of an exemplary handle 14. The near end includes a plurality of apertures through which cables such as optical input cable 56 may pass. The optical input cable 56 includes a standard optical fitting 60 such as an ACMI coupling for connecting a light source and a cable. The aperture 52 is sized to receive the various cables and to hold the cables in place by press fit. This places the cable on one side of the handle to help manage the cable and keep the cable away from the path. The aperture 52 preferably allows the cable to slip into the center channel 24 with respect to the near end of the handle, which can be optically coupled to the illumination blade device through the center channel at an angle to the interior. Similarly, the smaller aperture 54 may also be disposed at the near end of the handle 14 to receive other tubing or cables, such as the suction tube 62. A connector 58, such as a Luer connector, allows the suction tubing to be coupled in fluid communication with a vacuum source for smoke emission or flue gas. The suction tube can be advanced to the aperture 54 until the connector 58 is press fit into the aperture to maintain the tubing in place. A smaller aperture 54 may also be angled inwardly and integrated with the center channel 24 or the aperture 54 and center channel 24 may be formed in the channel 42, Individual channels can be maintained in the full path through.

In addition, the retractor can be held in the desired position and coupled with a strong arm or other robust coupling that the physician or assistant's hand can free. Stronger can be attached to the surgical table, the wall of the operating room, or on a separate cart or table. Generally, strong arms are also adjustable to hold the retractor in various positions. A weight can also be attached to the handle to hold the retractor in a desired direction.

Adjustment of Retractor Blades

6A shows a typical retractor blade 12 coupled to a handle 14. Fig. The blade 12 forms an angle [theta] with respect to the handle. In Figure 6a, the retractor blade is substantially orthogonal to the handle 14, i.e., [theta] = 90 [deg.]. However, in certain situations, it is beneficial to adjust θ to a different angle. Thus, any retractors disclosed herein may have an adjustment mechanism that allows the angle [theta] to be adjusted. This is commonly referred to as blade toe-in or toe-out adjustment. 6B illustrates how the blade can be moved to the exterior or distal end 66 such that? Is at an obtuse angle while FIG. 6C shows how the blade is moved to the interior or near end 68 of the retractor blade 12, Lt; / RTI >

Those skilled in the art will appreciate that any number of mechanisms can be used to enable adjustment of theta. However, in a preferred embodiment of the surgical retractor, the illuminator blade device is coupled to the handle and disposed on the blade of the retractor, the suction tube is coupled to the retractor blade for exhausting the smoke, and the optical input cable is coupled to the illumination blade device . Thus, a pivoting mechanism that allows adjustment of the toe or toe out should not only accommodate the suction tube and the optical cable, but also maintain the position of the illumination blade relative to the retractor blade. Thus, the adjustment mechanism allows the retractor blade to be pivoted without changing the relative position of the reticle blade and the retractor blade. In addition, the instrument allows to move without unnecessarily pulling the suction tube and the illumination cable.

In one exemplary embodiment, the adjustment mechanism may comprise a spline pin disposed laterally at the distal end of the handle 14. [ 7A shows a retractor blade 12 having a spline channel 74 extending laterally through a retractor blade and a spline pin 72 passing therethrough. The spline pin 72 is also disposed at the distal end of the handle 14. 7B is a side view of the retractor blade 12 that fits the spline channel 74 in the retractor blade. When the spline pin 72 is pulled from the spline channel 74, the retractor blade 12 can be pivoted about the angle [theta]. Once the desired angle is set, the pin can be repositioned in the spline hole 74 to lock the retractor blade in place. Although the splines can be adjusted for each pitch, in the preferred embodiment, the splines are spaced so that the retractor blades can be adjusted every 5 [deg.], More preferably every 3 [deg.], Most preferably every 2 [ It is separated. Those skilled in the art will appreciate that any pitch can be used, and thus the exemplary pitch is not intended to be limiting. The spline pin 72 can also be spring loaded so that the operator can push the spline pin 72 out of the path to make the retractor blade adjustment and the spring engages the spline hole 74 to lock the pistol- To push the spline pin again. Figure 7c shows the retractor blade 12 associated with the handle, and the blade illumination device 1209 is coupled with the retractor blade. The spline pin 72 is shown more clearly in the figure.

Retractor blade

8A shows a side view of a surgical retractor having a handle 14 and a retractor blade 12. In this exemplary embodiment, the retractor blade 14 is disposed in a plane transverse to the plane on which the handle 14 rests. In the embodiment of Figure 8A, the retractor blade is orthogonal to the handle. The retractor blade 12 includes a distal tip 82 that can be bent upwards to make a proximal end of the handle. Any of the surfaces of the retractor blade and / or distal tip may be textured to facilitate gripping of tissue during traction. Figure 8b shows a cross-sectional view of the retractor blade of Figure 8a. The upper surface 88 of the retractor blade may be concave, and the slotted area or channel 86 may extend along the length of the retractor blade. The grooved area accommodates the light elements described in the text. Additionally, the plurality of channels 84 run along the length of the retractor blade 12, and the channel 84 can be used to suck up smoke or noxious fumes from the surgical area, as described further below . The length, width, and thickness of the retractor blade can be any size suitable for target dissection. Preferably, a plurality of different retractor blades are provided for the operator to select a retractor blade that is most suitable for treatment. In addition, the retractor blade may also include a wing 90 on either side of the retractor blade 12, as in Fig. The wings 90 increase the area of the retractor blade to help prevent tissue from unwinding from the retractor blade during traction, as well as allowing more tissue to be pulled. Figure 9 also shows how the distal tip 82 of the retractor blade is replaceable so that a surgical tip can be replaced with a distal tip that is more suitable for performing. These tips can be sterilized. The distal tip may be compression fit, snap fit, or mechanically coupled to the retractor blade. In another embodiment, the distal tip is fixedly attached to the retractor blade. The distal tip may have any number of geometries that help traverse the tissue. For example, the distal tip may be curved upward, or may be flat or planar. The distal tip may also include a textured surface 94 to help hold tissue during traction. Texturing may be machined directly into the distal tip 82, or in other embodiments, the texturing may be removably attached to the distal tip. Exemplary texturing may include knurling, teeth, or rough surfaces. Rubberized surfaces can also be used to aid tissue maintenance. In addition, the non-slip feature can be removably applied to the retractor blade using a texturing tape, plastic sleeve, fiber sock, or polymer tip. In another embodiment, the retractor blade may include perforations, including holes or slots, that help hold the tissue placed in the fenestration during traction. The retractor blade may also be integral with or attached to the blade illuminator and may include a protuberance protruding through the retractor blade aperture or slot to help secure the blade illuminator to the retractor blade.

10A shows a surgical retractor having a handle 14 having a retractor blade 12 and a detachable distal tip 82. As shown in FIG. The cover 102 may be disposed on the distal tip so that different texturing may be applied to the distal tip. The cover may be removed and discarded postoperatively to facilitate washing and resterilization of the retractor when reusable. In some embodiments, some or all of the components of the surgical retractor may be used only once and discarded after use. Figure 10B shows the distal tip 82 of the retractor blade 12 when the cover 102 is placed thereon. In another embodiment, the retractor blade may have a fixed or retractable barb that helps grip tissue. Figure 10c includes teeth 83 that help the distal tip of the retractor blade 12 grab tissue or assist in cutting tissue with the retractor blade.

The retractor is usually used with electrosurgical equipment. Because the retractor blade is close to the electrosurgical probe, unwanted arcs can occur between the retractor blade and the electrosurgical probe. Therefore, it is desirable to insulate all or a portion of the retractor blades. This can be accomplished by fabricating a retractor blade with a non-conductive material such as a polymer or ceramic, or it can be achieved by forming a blade with a non-conductive coating, such as a polymer, such as parylene or anodized, Lt; / RTI > Retractor blades of any feature disclosed herein may be used in any other embodiment of the retractor blades described herein.

Lighting blade device

Figures 11A-11E illustrate the coupling of an illumination blade apparatus with a retractor and a handle. 11A, the retractor blade 12 is already engaged with the handle 14, although the retractor blade can be engaged after the illuminator is engaged with the handle. The distal end of the handle 14 includes a slot 1104 releasably attaching the illuminator to the handle 14. The channel or slot 1102 in the retractor blade 12 allows the illumination blade apparatus to be disposed therein. In FIG. 11B, an illumination blade apparatus 1108 is coupled to a cable 56 to optically couple the illumination blade apparatus 1108 with a light source (not shown). In another embodiment, the light pipe or optical fiber is fixedly coupled to the handle and the illumination blade device can be coupled to the end of the light pipe or optical fiber, and the near end of the handle is then coupled to the light source. Thus, the cable does not have to be provided in any path through the handle.

The illumination blade device 1108 preferably includes a light output zone 1116 in which light is extracted from the illumination blade and directed toward the surgical area. In addition, an engagement element, such as tab 1110 in the dead zone of the illumination blade, maintains an air gap between the active zone of the illuminator blade and the retractor blade, while the blade illuminator 1108, So that it can be placed opposite to the blade. In addition, the shield 1112 disposed on a portion of the blade illumination device prevents it from being damaged while it is being used or other surgical instruments that are scratched or touched, and prevents flashing of the flash back to the operator's face. Plate 1114 allows the blade illuminator to be releasably engaged with the handle by hanging or snapped or placing plate 1114 into slot 1104. 11C is a perspective view of a surgical retractor after the illumination blade apparatus is engaged with the handle. The cable 56 is exposed close to the distal end of the handle in the open channel 26 but as a result the cable is pulled out of the handle 26 until the cable reaches the proximal end of the handle through the positioning aperture 52, (24) in the channel (14). The cable 56 may then be optically coupled to the light source. 11D is a top view of a surgical retractor showing an illumination blade assembly engaged with a handle and engaged with a retractor blade.

Figures 11F-11G illustrate various sizes of illuminator blades 1108 disposed in the channels of the retractor blades 12. The illuminator blade 1108 may have a width that extends across the width of the retractor blade channel, as shown in FIG. 11F, or the illuminator blade 1108 may be narrower than the channel, as shown in FIG. 11G. Additionally, the length of the fixture blade may be any length from a length greater than the retractor blade to a length shorter than the retractor blade, or the fixture blade may have the same length as the retractor blade.

Figure 12a more clearly illustrates engaging an illuminator blade device (also referred to herein as an illuminator blade) with a retractor blade. The illuminated retractor 1207 consists of a retractor blade 1208 and an illuminator blade 1209. The retractor blade 1208 may be used with any of the embodiments disclosed herein, and the retractor blade may be used with other retractor systems, such as a McCulloch traction system. Retractor blade 1208 includes one or more mechanical connectors and may be releasably coupled to any of the handles described herein. Any coupling mechanism disclosed herein may be used. A neck slot or channel 1210 accommodates a neck zone 1224 of the illuminator blade 1209 and a blade slot 1211 is positioned between the fixture blade and the retractor 1210 while maintaining an air gap between the illuminator blade and the active zone of the retractor And receives the output blade 1225 of the illuminator blade 1209. Two or more engagement elements, such as a blade or plate 1212 and a tab 1214, secure the illumination blade 1209 with the retractor blade 1208. Each tab 1214 engages one or more mating receptacles, such as a receptacle or recess 1215. The plate 1212 is coupled to the collar 1216 and the collar encloses the illumination blade input 1218 as shown in Figure 12C when the collar 1216 is releasably engaged with the input dead zone 1222D. The removable engagement of the collar 1216 with the input dead zone 1222D also causes the plate 1212 to contact the end surface 1219 of the retractor blade. The collar 1216 airtightly engages the dead zone 1222D, surrounds the cylindrical input zone 1220, and forms the input air gap 1220G. Engagement in the dead zone minimizes interference with the optical path by means of an engagement element such as plate 1212 and tab 1214. The plate 1212 engages the end surface 1219 and the tab 1214 engages the retractor blade 1208 with the illumination blade 1208 without contact between the illumination blade 1209 and the active zone of any portion of the retractor blade 1208. [ The engaging portion 1215 is resiliently engaged to hold the engaging portion 1209 fixedly.

The illumination blades 1209 receive light from the illumination blade input 1218 of the cylindrical input section 1220 into one or more output sections and output ends 1233, such as output sections 1227 through 1231, as shown in Figures 12d through 12e. And to form a series of active zones for conducting light. The illumination blade 1209 also includes one or more dead zones, such as regions 1222D, 1226D, and 1226E. The dead zone is oriented to minimize light entering the dead zone, minimizing the escape of light in a potentially unintended direction. The coupling element is an ideal position for fixing the illumination blade to the retractor since the light that is in the dead zone or transmitted through the dead zone is minimized by total internal reflection.

Light may be any conventional instrument such as a standard ACMI connector with a 4.2 mm diameter that focuses light from a 3.5 mm fiber bundle with 0.5 NA with a 0.5 mm gap between the end of the fiber bundle and the illumination blade input 1218 To an illumination blade input 1218 using a light source. The light incident on the illumination blade input 1218 passes through the entirely cylindrical active input zone 1220, enters the illumination blade, passes through the active input transition 1222 to the generally rectangular active retractor neck 1224, Passes through an output transition 1226 and moves to an output blade 1225 that includes active zones 1227 through 1231 and active output end 1233. The neck 1224 is generally rectangular and is square adjacent the input transition 1222 and the neck configuration changes toward a rectangular cross-section adjacent the input transition 1226. The output blade 1225 has a generally rectangular cross section with a high aspect ratio that results in an overall large and thin blade. Each zone has an output surface area that is larger than the input surface area, and is arranged to reduce the temperature per unit output area.

In the illustrated configuration, the illumination blade 1209 includes at least one dead zone, and the dead zone 1222D entirely surrounds the input transition 1222. [ One or more dead zones at or near the output of the illumination blade provide a position for the engagement element, such as a tab, which causes the illumination blade to stably engage the retractor. This stable engagement assists in the maintenance of air gaps such as air gaps 1221 adjacent to the active zones of all illumination blades, as shown in Figure 12c. The neck portion 1224 ends the size 1232 adjacent the output transition 1226 extending to size 1234 in the output zone. Changing the size brings dead zones 1226D and 1226E adjacent to output transition 1226. [ These dead zones are suitable locations for mounting the tabs 1214 to minimize the effect of the engagement element on the optical path.

The engagement element is aligned to form an engagement axis, such as an engagement axis 1236 parallel to the optical input axis 1238, to minimize stress on the optical input and / or stresses exerted by the optical input to the illumination blade.

Output zones 1227, 1228, 1229, 1230 and 1231 have similar configurations with different sizes. Referring to the detailed view of Figure 12D, the characteristics of the output zone 1227 are illustrated. Each output zone may be in the form of a parallel prism having a facet or first facet 1240 with length 1240L or a facet or second facet 1242 with a first facet 1242L and length 1242L . The facets are oriented in a plane 1243 that is parallel to and thick in thickness or depth from the back surface 1245. In the illustrated configuration, all of the output zones have the same depth 1244 from the rear surface.

A first facet of each output zone is formed at a first angle 1246 from a plane 1243. A second facet, such as facet 1242, forms a second angle 1247 with respect to a first facet, such as first facet 1240. In the illustrated configuration, the output zone 1227 includes a first facet 1240 having a length 1240L of 0.45mm at a first angle of 27 degrees and a second facet 1240 having a length 1242L of 0.23mm at a second angle of 88 degrees. Lt; / RTI > The output zone 1228 has a first facet 1240 having a length 1240L of 0.55mm at a first angle of 26 degrees and a second facet having a length 1242L of 0.24mm at a second angle of 66 degrees. The output zone 1229 has a first facet 1240 having a length 1240L of 0.53 mm at a first angle of 20 degrees and a second facet having a length 1242L of 0.18 mm at a second angle of 72 degrees. The output zone 1230 has a first facet 1240 having a length 1240L of 0.55mm at a first angle of 26 degrees and a second facet having a length 1242L of 0.24mm at a second angle of 66 degrees. The output zone 1231 has a first facet 1240 having a length 1240L of 0.54mm at a first angle of 27 degrees and a second facet having a length 1242L of 0.24mm at a second angle of 68 degrees. Thus, in a preferred embodiment, the first facet 1240 forms an acute angle with respect to the plane on which the rear surface 1245 lies, and the second facet 1242 in the preferred embodiment has a rear surface 1245 Forming an obtuse angle with respect to the plane. These preferred angles allow light to be extracted from the illuminator blades so that the light escapes laterally and laterally toward the surgical area in an efficient manner, allowing the illuminator blades to be injection molded and easily ejected from the mold. Other angles are possible, as will be appreciated by those skilled in the art.

The output end 1233 is in the final active zone of the illumination blade and is shown in detail in Figure 12D. The rear retractor 1248 forms an angle 1249 with respect to the front surface 1250. The front surface 1250 is parallel to the rear surface 1245. The terminal facets 1252 form an angle 1252 with respect to the front surface 1250. In the illustrated configuration, angle 1249 is preferably 32 degrees and angle 1252 is preferably 95 degrees. The geometry of such an end tip assists in preventing light from being reflected back toward the doctor in the near-end direction, thereby helping to block flashing.

Other suitable configurations of the output structure may be introduced into one or more output zones. For example, the output zones 1227 and 1228 may introduce a concave curve downward, the output zone 1229 may remain generally horizontal, and the output zones 1230 and 1231 may introduce a concave curve upward. Alternatively, the plane 1243, which is a plane inside the output structure, can be a spherical portion having a large radius of curvature. Plane 1243 may also introduce sinusoids or other complex geometry. Geometries can be applied both vertically and horizontally to form a composite surface.

In another configuration, the output zone may provide illumination at two or more levels throughout the surgical site. For example, output zones 1227 and 1228 cooperate to illuminate a first surgical area, output zones 1229 and 1230 cooperate to illuminate a second surgical area, output zones 1231 and 1233 cooperate to illuminate a second surgical area, Area can be illuminated. This configuration eliminates the need to redirect the illumination element during surgical procedures.

Smoke

A number of surgical retractors are used with electrosurgical instruments such as RF probes for cautery. Electrosurgical instruments usually cover the field of view and produce unpleasant smoke or other harmful smoke. Thus, the surgical retractor may also include features for flushing. Typically, the smoke or noxious smoke is discharged separately from the retractor or with a vacuum tube associated with the retractor. The vacuum line may be coupled to a vacuum tube and smoke or noxious fumes may be vented. A disadvantage of these systems is that individual vacuum tubes take up precious space in already crowded surgical areas. As the incision becomes smaller and smaller, it becomes more important to reduce the volume of the surgical instrument. Therefore, it would be beneficial to provide a surgical retractor capable of discharging smoke or toxic gas without taking up additional space.

Figures 13a-13c illustrate an exemplary embodiment of a retractor with an internal smoking system. In Figure 13A, the retractor includes a handle 14 and a retractor blade 12. The handle 14 and the blade 12 may be any of the handles or blades disclosed herein. The retractor blade 12 includes a plurality of longitudinally extending channels 1302 along the length of the blade. While only one channel is required, the preferred embodiment has multiple channels. When a single wide channel is involved, other surgical instruments may be retained within the channel between the retractor blade and the wing or illumination blade disposed thereon. Thus, it may be beneficial to use multiple narrow channels to minimize the likelihood that the device is caught. The channels can be parallel to each other, or other geometry is possible. An illumination blade apparatus (also referred to as a blade illuminator or an illumination blade) is then sealingly disposed on the channel and can be coupled with the retractor blade to form a gap or plenum between the channel and the bottom surface of the illuminator blade. The vacuum tube can then be combined with the retractor blade so that the smoke is discharged from the surgical area along with the plenum. Thus, the smoke is discharged without the need for additional tubing occupying the space of the surgical area. Depending on the size and length of the illuminator blades used to provide light to the surgical area, the blades may not be able to cover enough channels to create a proper vacuum for effective flushing. Thus, in some cases, as shown in FIG. 13B, a cover or vane 1304 can be placed on the channel to accommodate different illuminator blades as well as control the size of the vacuum generated. The cover or wing 1304 can be press fit into the retractor blade and disposed on the channel 1302 to form a plenum or the wing 1304 can be slidably advanced along the slots in the retractor blade . In another embodiment, the vane 1304 can be combined with a blade illuminator. The blade illuminator and wings are then combined with the retractor blades to maintain an air gap between the upper surface of the wings and the lower surface of the active zone of the illuminator blade to minimize the light loss, Cover enough space. Figure 13C shows a blade illuminator 1306 disposed over a wing 1304 disposed on a plurality of channels 1302. [ The bottom surface of the wing may be fitted to the same surface with respect to the top surface of the channels to prevent the surgical instruments from being caught. Similarly, in embodiments where the blade illuminator is disposed directly above the channels without wings, the tip of the blade illuminator may be fitted to the same surface with respect to the top surface of the channels to prevent other surgical instruments from being caught. Thus, the plenum is formed by assembling the wing (s) and / or the illuminator blade with the retractor blade. A channel such as channel 42 (shown in FIG. 4) may pass through the handle wall and exit from the distal aperture 1308 of the handle 14. The vacuum tube is slidably disposed in the channel 42 and exits the aperture 1308 and is coupled with the retractor blade 12 to allow the plurality of channels 1302 to be coupled in fluid communication with the vacuum tube. In this or other embodiments, the vacuum tube may be automatically fluidly coupled with the retractor blade as the retractor blade engages the handle.

The wings 1304 may not be long enough to cover the channels 1302 in the retractor blade 12 in situations where a long retractor blade 12 is used. This prevents proper generation of air. Thus, in some embodiments, the second wing 1310 may be disposed and disposed relative to the retractor blade 12 to control the area of the channel 1302 that forms the plenum. The second wing may slidably engage the slots along the retractor blade side as shown in Figure 13d, or the second wing may be snap fit or positioned relative to the retractor blade. A gap is maintained between the bar membrane of the second wing and the channel so that smoke or toxic gas can be discharged. FIG. 13E shows a second wing 1302 that is disposed relative to the first wing 1304. The two wings may be adjacent to each other in a line, as shown in Figure 13f, or a joint such as a scarf joint may be used to join the ends as shown in Figure 13g. A number of other joints may also be used. In some embodiments, the two blades may be slidably disposed on top of each other, as shown in Figure 13H.

In either embodiment with one or two wings, the wing can be slidably moved along the longitudinal axis of the retractor blade. The part that is not covered ensures that the smoke is discharged at that location. Thus, by sliding the wings, the position of the smoke discharge can be controlled. This is advantageous in deep pockets where the treatment is performed at multiple levels. Thus, it may be advantageous that the smoke is discharged from the first level and then the smoke can be discharged from the second level.

Once the blade illuminator and wings are positioned relative to the retractor blade 12, the light source cable 56 can be coupled to the blade illuminator and the suction tube 62 can be coupled to the retractor blade as shown in FIG. 13i. 13J shows the near end of handle 14 having suction tube 62 and light input cable 56 extending through the handle as described above. Those skilled in the art will appreciate that the illuminator blades, handles, retractor blades, optical input cables, suction tubes, etc., in the embodiment of Figs. 13A-13J are similar to the illuminator blades, handles, retractor blades, optical input cables, It can be replaced.

In an alternate embodiment, the first wing 1360 may include a plurality of through holes 1362 as shown in FIG. 13K. The first wing 1360 is disposed opposite the retractor blade and also against a plurality of channels. The second wing 1364 is slidably disposed over the first wing 1360 as shown in FIG. The second wing 1364 controls how many of the apertures are exposed so as to control the magnitude of the suction provided by the vacuum to advance or retract slidably relative to the first wing as indicated by arrow 1366 It can be towed. 13M shows an alternative embodiment of a first wing 1370 having a tapered slot 1372 through the wing. When the second wing is advanced or towed, the size of the exposed slot is varied to control the suction provided by the vacuum.

Figures 34 and 35a-35d illustrate alternative embodiments of a vacuum channel that may be used in any embodiment of an illuminated retractor for venting as disclosed in this application. The channels may be machined in part, or the channels may be injection molded if the blades are molded. Figure 34 shows a retractor blade 3402 having an internal channel 3404 (opposite the open channel in the embodiment of Figures 13A-13M). The suction hole is formed through the outer surface of the retractor blade until the suction hole is engaged in fluid communication with the inner channel 3404. Internal channel 3404 may be a single channel or a plurality of channels. Preferably, the channels can be integrated into a single channel adjacent the proximal end of the retractor blade so that suction can be applied to the retractor blade at a single point. 35A-35B illustrate retractor blades with multiple open channels. For example, in Figure 35A, an open channel 3504a is disposed in the retractor blade 3502a. Two channels are merged into a single channel adjacent the near end of the retractor blade. The sliding cover or wing 3506a slides over the open channel to create a vacuum so that suction can be applied to the through-hole 3508a in the cover 3506a. 35B shows a similar embodiment with the main exception that the cover or wing 3506b is fixedly coupled to the retractor blade 3502b. Multiple vacuum channels are within the retractor blade. The vacuum is then drawn through the suction holes 3508b in the cover. Figures 35c and 35d show an embodiment of a retractor blade with a single open vacuum channel. The channel can be arranged to engage the retractor blade so that the slidable cover or wing 3506c is sealed to the vacuum channel and the vacuum is drawn through the suction hole 3508c in the cover. Figure 35d shows a similar embodiment except that the cover 3506d is secured to the retractor blade 3502d. Vacuum is applied through the single opening channel 3504d through the suction opening 3508d of the cover. Additionally, as described in more detail herein, the blade illuminator may be hermetic to the retractor blade to create a vacuum. Any of these embodiments may be used in an illuminated retractor with the smoke exhaust features disclosed herein.

Figure 14A shows a perspective view of the retractor in Figures 13A-13J. The smoke 1402 or other toxic gas generated by electrosurgery is drawn into the channel and then discharged through a suction tube disposed in the aperture 1308 of the handle 14. 14B shows a bottom view of the retractor blade 12 that discharges the smoke 1302. Fig.

In an alternative embodiment, the smoke exhaust channel may be integrated into a blade lighting device other than a retractor blade, or in other embodiments an exhaust channel may be placed in both the blade lighting device and the retractor blade. Other embodiments rely on a gap between the blade and the bottom surface of the blade lighting device to create a plenum for allowing smoke discharge.

Retractor blade and handle engagement

Any number of quick release mechanisms for engaging the handle and retractor blade may be used. The quick release mechanism or engagement mechanism should be easy to operate, and in some embodiments, one handed operation allows one handed engagement of the retractor blade and disengagement from the handle. The device preferably allows the handle and retractor blade to be cleaned and resterilized easily after use. In other embodiments, the device is a disposable use with other parts of the retractor including the handle, the retractor blade, and the illuminator blade. The engagement mechanism preferably allows any cable (e.g., an optical input cable) or tube (e.g., a suction tube) to release the retractor blade from the handle without having to be disconnected from the handle. Additionally, the mechanism preferably allows the retractor blade to be disconnected from the handle without the need for the blade illuminator to be disconnected from the handle. Numerous embodiments of fast release mechanisms have been described herein for purposes of illustration, and these embodiments are not intended to be limiting. Any quick release mechanism described herein may be used with any of the other components or features described herein. For example, any fast release mechanism described herein may be used with any of the handle, retractor blade, fixture blade, or smoke ejection embodiments described herein.

15A-15B illustrate an exemplary embodiment of a quick release mechanism that engages the handle 14 with the retractor blade 12. In this exemplary embodiment, the quick release mechanism includes an actuator switch 1502 that is slidably actuated as indicated by arrow 1504. 15A shows the switch in the engaged position, wherein the handle 14 is locked with the retractor blade 12. [ 15B shows the switch in the disengaged position such that the handle is released from the retractor blade 12. The actuator mechanism advances and retracts the engaging element 1508, such as a center post having an enlarged head or edge flanged area received in the slot 1506 on the retractor blade 12. When the switch is operated in the engaged position, the enlarged head is further urged into the receiving slot 1506 to create a friction fit that prevents separation of the two components. Activating the switch in the disengaging position pulls the head a little away from the receiving slot 1506 to release the friction fit and allow separation of the two components. The retractor blade is then released from the handle by advancing the retractor blade toward the end of the retractor blade in a plane transverse to the handle. Those skilled in the art will appreciate that the switch can also work in the opposite direction.

16A-16D illustrate another exemplary embodiment of a quick release mechanism for engaging a handle and a retractor blade. 16A shows the retractor blade 12 disengaged from the handle 14. The engagement mechanism includes a post 1604 having a T-shaped head 1602 or a lateral protrusion forming an enlarged head on the near end of the retractor blade. The T-shaped head 1602 is advanced toward the socket 1606 with the lateral portion aligned vertically such that the T-shaped head 1602 is received in the slot 1606. When the enlarged head is received in the slot, the retractor blade 12 may be rotated 1608 such that the lateral protrusion of the T-shaped head 1602 is captured in the socket 1606. In the preferred embodiment, only a quarter turn is required to engage the handle with the retractor blade as shown in Figure 16c. 16D more clearly shows how the lateral protrusions of the T-shaped head 1602 are captured in the slot 1612. FIG. A ball pawl 1610 disposed on the socket presses against the lateral protrusions to hold the protrusions in place. Releasing the retractor from the handle follows the reverse procedure. A quarter turn rotation of the retractor blade to the handle releases the lateral protrusion from the ball detent and the protrusions vertically so that the retractor blade can be pulled through the slot in the socket and released from the handle. This embodiment preferably only requires 1/4 turn for engaging or disengaging, while the other geometry permits more or less rotation of the retractor blade relative to the handle.

In the embodiment of Figures 16A-16D, an optional locking mechanism may also be used to lock the locking mechanism and prevent the retractor blade from being inadvertently detached from the handle. For example, in FIG. 17A, a rotating cam 1620 is disposed adjacent to the T-shaped head 162 and the socket 1606. When the T-shaped head engages the socket 1606, the cam 1620 may be rotated 1626 to lock the engagement mechanism. The cam has a rounded portion 1622 and a flattened portion 1624. When the flat portion 1624 is adjacent to the socket 1606 as shown in FIG. 17A, the flat portion does not block the slot, and thus the enlarged head can be placed inside the socket or removed from the socket. However, when the cam is rotated so that the rounded portion abuts the socket, the rounded portion interferes with the slot to prevent the enlarged head from slipping out of the socket, and confirms that it is locked. Figure 17B shows the cam at the locked position.

Figures 18a-18f illustrate another exemplary embodiment of an engagement mechanism for coupling a retractor blade to a handle. 18A shows a handle 14 having an engagement element 1802 extending from the distal end of the handle. The engagement element preferably has an enlarged head attached to the center post or a flanged center post at the edge. A spring loaded ball pawl 1804 is disposed on the engaging element 1802. The retractor blade 12 includes a slotted area 1806 with geometry sized and formed to receive the center post and the enlarged head. A receptacle (not shown) in the slotted area 1806 is sized to receive the ball pawl 1804. 18B shows the engaging mechanism more clearly. Thus, in operation, the retractor blades are advanced toward the handle and the proximal end of the retractor blade is slidably loaded over the central post and the enlarged head, so that they are received in the slots on the retractor blade. A slight upward force is applied to the retractor blade to snap the ball pawl into its corresponding receptacle and thereby engage the retractor blade and handle together. The retractor blade of the present embodiment is lifted in a plane transverse to it and is preferably lifted in a plane substantially parallel to the handle plane for engagement. 18C shows engagement of the handle and retractor blade and also shows the center post 1802 and the enlarged head 1804 disposed in the receiving slot 1806. As shown in Fig. Before or after engagement of the retractor blade and handle, a blade illumination device 1108 with or without a shield 1112 is coupled with the optical input cable 56 and then the handle 14 and the retractor blade 12, Lt; / RTI > A suction tube 62 is also slidably disposed on the handle and engaged with the retractor blade as described above. The retractor blade can be removed using the reverse procedure. By sliding the retractor blade across the plane of the handle and preferably sliding downward in a plane that is substantially orthogonal, the ball detent disengages from its corresponding receptacle, and then the retractor blade descends downwardly away from the handle And can be disengaged. Thus, the retractor blades can be disengaged without the need for any cables (e.g., optical input cables) or blade lighting devices to be removed. The suction tube 56 helps prevent disengagement of the retractor blade from the handle and thus must be pulled to disengage it from the retractor blade in the near direction. Another advantage of the present device as well as the other advantages disclosed herein is that the retractor blade can also be removed from the handle without touching the blade illumination device. This mechanism allows the blade illumination device 1108 or the shield 1112 to be moved away from the handle (not shown) without disconnecting the cable, as shown in Figures 18E-18F where the retractor blade is released away from the blade illumination device and cable 56. [ Since the mechanism allows the retractor blade to be easily separated from the handle.

18A-18F includes a handle 14 having an engagement element 1802 extending from the distal end of the handle. The engagement element preferably has an enlarged head attached to the central post or a central post with an edge flanged area. It may include a spring loaded ball pawl 1804 disposed on the engagement element 1802. The retractor blade 12 includes a slotted area 1806 with geometry sized and formed to receive the center post and the enlarged head. A receptacle (not shown) in the slotted area 1806 is sized to receive the ball pawl 1804. When the retractor blade engages the handle, the suction tube 62 can be slidably advanced in engagement with the retractor blade to engage the handle with the retractor blade and prevent unwanted detachment. Removal of the suction tube causes the retractor blade to be disengaged from the handle in a manner similar to that described above.

Figs. 19A-19B illustrate alignment features that can be used with any of the embodiments of Figs. 18A-18D or other embodiments disclosed herein. One side of the distal end of the handle 14 may include a rail 1902 and a mating rail 1904 may also be included on one side of the proximal end of the corresponding retractor blade 12. Thus, when the retractor blade is advanced and engaged toward the handle, the two rails 1902 and 1904 contact each other and slide relative to each other. This ensures proper alignment of the retractor blade and handle. It also provides a key mechanism that ensures that the retractor blade is inserted in the proper direction and does not come back. Figure 19a shows the retractor blade disengaged from the handle, Figure 19b shows the alignment rails engaged to each other and the two components engaged.

Figure 20 illustrates another exemplary embodiment of an engagement mechanism for coupling the handle together with any of the retractor blades disclosed herein. In addition, any other features such as blade illumination devices, suction, etc. may be used with this embodiment. The handle 14 includes an engagement element 2002 extending from the distal end to the distal end of the handle. The engagement element 2002 includes a center post similar to that described above and an enlarged head or edge flanged area. The slot 2010 on the near end of the retractor blade 12 is sized and formed to receive the engaging element. Unlike the previous embodiments, this embodiment does not include spring loaded ball pawls on the engagement mechanism, but alternative embodiments may include spring loaded ball pawls. A rotatable lever 2004 is coupled to the end of the handle and a spring loaded ball detent is included on a portion of the lever. Other features such as the flue channel 1302, alignment rails 1902 and 1904, and vacuum port 1308 generally take the same form as described above. 20 also shows the aperture 2008 at the retractor blade aligned with the vacuum portion 1308 when the channel 1302 is coupled in fluid communication with the vacuum. In use, the retractor blade is lifted into engagement with the handle so that the alignment mechanism 2002 is received in the slot 2010. Lever 2004 is then rotated from the unlocked position (pointing down in this embodiment) to the locked position (rotated outward) to lock the retractor blade into engagement with the handle. The ball pawl 2006 is locked to an outlet (not shown) on the retractor blade and provides appropriate force to prevent sudden disengagement of the lever. Additional details of the engagement mechanism are described in further detail below.

The engagement mechanism of Figure 20 allows the retractor blade to engage the handle before or after the blade illumination device is engaged with the handle. The engagement mechanism permits the detachment of this retractor blade without the operator needing to touch the blade lighting device and the cable, such as a light input cable, need not be disconnected. Figures 21a-21c illustrate an embodiment in which the blade illumination device is coupled with the handle before the retractor blade is engaged with the handle. 21A, a blade illumination device 1108 is attached to the handle 14 and a light input cable 56 is also optically coupled to the blade illumination device. The blade lighting apparatus generally takes the same form as the embodiment of Figs. 12A-12E and may be attached to the handle in the same manner as described above in Figs. 11A-11E. The embodiment of FIG. 21A also includes a wing 1304 attached to a portion of the shield 1112. The vane 1304 can be any of the embodiments described above and is used to create a plenum for flue gas. Lever 2004 is in the disengaged position, and then retractor blade 12 is advanced towards the handle as shown in Figure 21B. The blade illumination device 1108 and the wing 1304 are slidably disposed in the center channel of the retractor blade, and the retractor blade is lifted perpendicular to the handle. The retractor blade is lifted in a plane transverse to the plane of the handle and preferably substantially perpendicular to the handle. When the retractor blade is aligned with the handle and the blade illumination device is properly positioned adjacent the retractor blade, the lever 2004 is rotated to the engaged position, as shown in Figure 21C, to lock the retractor blade to the handle.

In an alternative embodiment, the retractor blade is first attached to the handle, and then the blade illumination device can be engaged with the handle as shown in Figs. 22A-22B. In Figure 22A, the retractor blade 12 engages the handle 14 and the lever 2004 is rotated to a locked position similar to that described above. A blade illumination device 1108 with a shield 1112 is then engaged with the handle and disposed opposite the retractor blade. The cable 56 then optically couples the blade illumination device 1108 with the light source.

Figures 23A-23E more clearly illustrate how the mechanism in Figure 20 allows fast release of the handle and retractor blades. In Figure 23A, the retractor blade 12 already engages the handle 14. Lever 2004 is in the engaged position to form a horizontal plane on which shoulder 2302 rests and to prevent the retractor blade from slidably disengaging from the handle. The blade illumination device 1108 with the shield 1112 is locked against the handle and disposed against the retractor blade. Cable 56 optically couples the blade fixture device to the retractor blade. The suction tube 62 is in fluid communication with the retractor blade through an aperture 1308 to allow smoke or noxious fumes to exit the surgical area. The suction tube 62 prevents rotation of the lever so that the lever is locked in the engaged position. If the operator wishes to change the retractor blade, the suction tube 62 is pulled to the near end, as shown in Figure 23B, so that it is released from the aperture 1308. The engaging lever 2004 is then rotated to a disengaged position that is rotated counterclockwise from the clockwise direction to the 6 o'clock position in Fig. 23c so that the lever is no longer engaged with the shoulder 2302 of the retractor blade. The lever also deviates from the path of the shoulder 2302 such that the retractor blade slides downwardly away from the handle 14 and the engaging element 2002 is released from the slot 2010. The retractor blade is disengaged in a plane transverse to, and preferably substantially parallel to, the plane of the handle. This is also the distal direction toward the distal end of the retractor blade. The light from the illumination blade device is also extracted and directed in this direction. The retractor blade can be disengaged from the handle without having to touch the blade illuminator 1108 and a cable such as the optical input cable 56 need not be disconnected from the blade illuminator. Also, the blade illumination device 1108 with the wings 1304 need not be disconnected from the handle during the retractor blade change. 23D illustrates that the retractor blade is disengaged from the handle and the blade illumination device remains coupled to the handle. When the original retractor blade is removed, the second retractor blade slides back into position and engages the handle as shown in Figure 23E using the opposite procedure. When engaged, the lever (2004) is rotated to form a shelf that prevents the shoulder (2302) from moving so that the handle and the retractor blade are locked. The suction tube 62 is advanced back to the aperture 1308 and engaged with the retractor blade. Again, this process is performed without touching the blade illumination device or without disconnecting any cables as described above, and the blade illumination device can remain engaged with the handle while engaging.

Other engagement mechanisms may be used to releasably couple the retractor blade to the handle. For example, spring buckles with latches, sliding prongs, and threaded fasteners can also be used. Figures 32a-32d illustrate another exemplary embodiment of an illuminated retractor with releasable blades. The retractor includes a handle 14, a blade 3202, and a blade illuminator 3210. The handle 14 includes a flange portion 20 that helps the surgeon pull the tissue and channels 3216 and 3218 on the wall of the handle 14 for the suction tube and optical fiber, respectively. The blade illuminator 3210 is fixedly or releasably coupled to the handle 14 and is optically coupled to an optical fiber cable disposed in the channel 3218. The retractor blade 3202 includes a vacuum channel 3206 and a vacuum hole 3204 in the blades to allow harmful fumes and smoke to be drawn into the vacuum channel. The retractor blade 3202 is pivotally coupled to the handle 14 such that the retractor blade has a retracted position (see Figure 32A) and an unfolded position (see Figure 32B). In the retracted position, the retractor blade is placed substantially parallel to the handle body 14. When the retractor blade is pivoted away from the handle and pivoted outwardly, the retractor blade preferably expands to a position orthogonal to the handle plane that locks it into position with detents or other locking mechanisms known in the art. When the retractor blade is locked in the extended position, the blade is substantially parallel to the blade illuminator. In addition, the vacuum fitting 3208 on the retractor blade engages port 3218 on the handle associated with suction lumen 3216. Thus, when the retractor blade is expanded, the suction is automatically engaged with the handle. In addition, the retractor blade can be pulled to engage the blade fixture and the two elements can be locked together. In an alternate embodiment, the vacuum channel is an open channel, and the retractor blade seals and engages the illuminator blades to seal the channels so that suction can be applied to the vacuum holes 3204. The retractor blade fits in the space 3214 created between the blade illuminator and the end of the handle. When the retractor blade is expanded, the retractor blade can be inserted into the surgical area for traction of the tissue. Light 3220 is extracted from the blade illuminator through surface features 3212 and directed toward the surgical area. The retractor blade may also be releasably coupled to the handle such that it can be replaced with a retractor blade having a different configuration. Any of the features of the embodiments described above can be combined with or replaced with the features of the embodiment in Figures 32A-32B. Similarly, the features of the embodiments in Figures 32A-32B may be used in any of the embodiments disclosed in any portion of the disclosure.

Figure 33 illustrates another exemplary embodiment of an illuminated retractor with releasable retractor blades. Handle 14 and flange 20 generally take the same form as in the previous embodiment. The blade illuminator 3202 is also fixedly or releasably coupled to the handle 14 with an end 3206 of a retractor blade having a vacuum channel 3208 and a fitting 3210. End 3206 may be shorter, the same length, or longer than blade illuminator 3202. Retractor blade extensions 3212a, 3212b, and 3212c of varying lengths and geometries can then be combined with end 3206 according to the anatomy being processed. Fitting 3216 for the various retractor blade extensions 3212a, 3212b and 3212c allows the retractor blade to releasably engage the end 326 of the retractor blade and the fitting 3210. [ The suction lumen 3208 at the end 3206 can be engaged with the suction lumens 3214a, 3214b, and 3214c at the extension. The suction line at the handle 3204 can be coupled to the suction lumen 3208 at the end and coupled to an external vacuum source. Any feature of this embodiment may be replaced with, or be combined with, the features of any other embodiment disclosed herein. Similarly, any feature in this embodiment may be used in any other embodiment described herein.

Operation method

The preferred retractor blade 12 and handle 14 are selected and engaged using any of the engagement mechanisms described herein and preferably the blade illumination device 1108 is coupled to the handle and the optical input cable 56 is coupled to the blade When the illumination device is optically coupled to the light source, the retractor can be used to pull the tissue, illuminate the surgical area, and evacuate smoke or toxic gases therefrom, as shown in Figures 24a-24e.

24A shows an assembled retractor disposed adjacent incision I; The retractor can be used to pull any tissue, but is preferably used to pull the soft tissue, such as in breast or thyroid surgery. In Fig. 24B, the distal tip of the retractor blade is advanced into the incision, and in Fig. 24C, the retractor blade is retracted here in a vertical direction in a vertical direction to pull the tissue and create the pocket 2402. Fig. The surgical instruments, equipment, and physician's hands may be placed in the pocket 2402 to perform diagnostic or therapeutic procedures. Since it is difficult to see in the pocket, the blade illuminator 1108 is also advanced to the pocket when the retractor blade is inserted into the pocket, illuminating the pocket as shown in Figure 24D. In addition, an electrosurgical instrument 2404, such as a cauterizer, can generate smoke or other harmful fumes that can be discharged using the smoke features described above. The physician may vary the retractor blade at any time during treatment to accommodate various anatomical structures, sagging directions and pseudo positions. As noted above, any feature described in the text may be used in the exemplary method, and one of ordinary skill in the art will appreciate that any number of combinations or alternatives is possible.

Thyroid Retractor

The surgical pull retractor embodiment described above is preferably used to pull soft tissue during a procedure such as breast surgery. The following alternative embodiments are similar to those described above, but have other atherosclerotic structures such as thyroid surgery and modifications desirable to accommodate soft tissue traction in treatment. The following embodiments may be combined with or substituted for any of the features described above. For example, any of the handle, retractor blade, or blade adjustment features may be readily incorporated into the embodiments described below. In addition, an illumination blade feature, flue, and blade handle engagement mechanism may also be used in the embodiments described below. Thus, those skilled in the art will appreciate that any combination of the features described above may be used with or replaced with any feature described herein. Similarly, any of the features described below may be used with and replaced with the embodiments described above.

Referring to Figure 25, the illuminated soft tissue retractor 2510 includes a retractor assembly 2512, an illumination waveguide assembly 2514, and an illumination assembly 2515. The near-end protrusion 2517 extends entirely from the retractor body 2512A in an orthogonal manner. Retractor blade 2512B may be coupled to the distal end of retractor body 2512A and may include a proximal end generally coplanar with retractor body 2512A, and a traversing end therethrough. In some embodiments, the distal end of the retractor blade is orthogonal to the proximal portion of the retractor blade, although other angles can be used. The near-end protrusion 2517 optimizes the application of counter traction without having to squeeze the retractor body 2512A, which usually results in fatigue. The proximal projection 2517 can be further weighted to balance the instrument as well as allowing the retractor to provide counter shrinking by itself. The near-end protrusion 2517 may be formed of a material heavier than the retractor body 2512A or the retractor blade 2512B. Alternatively, it may be hermetically sealed within one or more additional near-end protrusions 2517, such as a weight 2516 (best seen in FIG. 28) for controlling the position of the center of mass 2525, as shown in FIG. 28 . The weight 2516 can be releasably connected to the near-end protrusion 2517 by placing the weight at a plurality of apertures. The weights can be threadably machined, press-fit, or coupled with the near-end protrusions. The aperture can also be machined or formed as a near-end protrusion for the proper weight of the assembly.

The configuration of adjacent protrusions 25417 allows for more self-traction by including a generally flat foot or surface 2518 to prevent rolling and slippage of the retractor when it provides self-traction. The retractor body 2512A includes a channel 2519 that receives and engages the illumination assembly 2515 within the overall profile of the retractor body 2512A. The illumination assembly 2515 preferably includes a cable that optically couples the waveguide assembly 2514 with a light source (not shown). The near end of illumination assembly 2515 may include standard optical connectors such as an ACMI connector for optically coupling a light source and cable.

Referring to Fig. 26, the retractor assembly 2512 has a distal end 2512D and a proximal end 2512P. The proximal end 2512P includes an adjacent protrusion 2517 and the distal end 2512D includes a retractor blade 2512B. The retractor blade 2512B includes a waveguide socket 2520 that engages the illumination waveguide assembly 2514. [ Such as a clip socket 2521 for maintaining the total internal reflection (TIR) of light conducted through the waveguide by further engaging the light waveguide assembly 2514 and minimizing contact between the retractor blade 2512B and the waveguide assembly 2514 One of the additional waveguide hermetic elements is also included. Where the contact between the retractor blade 2512B and the waveguide assembly 2514 can not be eliminated, where the transmission efficiency is maintained by controlling the contact and minimizing the likelihood of escape of light at the contact point (s). The waveguide may have an active zone through which light is transmitted and transmitted by total internal reflection and a dead zone where light is not substantially transmitted by total internal reflection. The contact between the waveguide and the retractor blade is preferably limited to the dead zone of the waveguide to minimize light loss. Additionally, in a preferred embodiment, an air gap is maintained between the waveguide and the active zone of the retractor blade to minimize light loss again.

27, the waveguide assembly 2514 includes a waveguide 2514W configured to provide optimal optical conduction using the total internal reflection (TIR) of the incident light incident through the optical input 2522. [ The optical input 2522 preferably has a round or cylindrical input that then transitions to a square or rectangular portion that is then coupled to the remainder of the waveguide. This transition zone produces a dead zone in the square or rectangular portion of the optical input 2522 where light is not substantially transmitted by the TIR, and thus this portion of the waveguide minimizes optical loss due to contact between the waveguide and the clip To the clip 2527, as shown in Fig. The use of TIR provides optimal efficiency and enables the best available light and optimal orientation of light 2523 at first output surface 2524 and second output surface 2526 (best seen in FIG. 30) . The light from the first output surface 2524 is preferably directed laterally from the waveguide illuminating the surgical area as indicated by the arrow, diverging from the output surface 2524. [ The waveguide 2514W may engage a clip such as the clip 2527 to secure the waveguide 2514W with a retractor blade connection such as a clip socket 2521. [ The clip also allows the optical input cable (not shown) to releasably couple with the optical input 2522, and the clip also maintains an air gap around the cylindrical or rounded portion of the input 2522 to maximize light transmission efficiency do. One or more shields, such as optical shield 2528, may also be included in waveguide assembly 2514. The shield may be coupled with a clip 2527 to prevent direct contact with the waveguide, and the shield may protect the operator from glare that may be visible again to the operator ' s eye, Lt; / RTI > Fig. 30 shows a side view of the waveguide assembly 2514 shown in Fig.

28, the retractor assembly 2512 includes a retractor body 2512A and a retractor blade 2512B. The retractor blade 2512B is matched to the retractor body 2512A in the transition zone 2529 along interface 2513. The transition zone 2529 is configured to create a drop angle 2530 between the blade axis 2532 and the retractor axis 2534. Drop angle 2530 is ideally between 5 and 35 degrees, although other suitable angles may be used. For thyroid surgery, the drop angle 30 is about 15 degrees. The retractor blade length 2536 and the retractor blade depth 2537 may employ any suitable size depending on the type of operation being predicted. For thyroid surgery, a blade length of 30-50 mm and a blade depth of 25-60 mm are presently preferred. Of course, any size may be used, and the exemplary scope is not intended to be limiting. The inclinatiion angle of the retractor blade, angle 2538, may take any suitable angle. For thyroid surgery, a blade tilt angle 38 of 90 degrees is presently preferred.

The retractor blade 2512B has a proximal end 2540 that is secured to the retractor body 2512A at the interface 2513. The end 2542 of the retractor blade is configured to be optimally useful in minimally invasive surgery. Retractor blade 2512B is generally narrow along depth 2537. In minimally invasive procedures, it is important to allow the tool to perform one or more functions to save time and minimize movement of the surgical team. A distal end 2542 with a trapezoidal tip 2543 is constructed. In the outlined and other treatments described below, an illuminated soft tissue retractor, such as retractor 2510, may be used for tissue traction as well as blunt dissection. It is essential to control the magnitude of the force applied to the tissue to be incised, around the sensitive structure, and expanding the tip width 2544 will increase the contact area with the tissue being pulled and the force per unit area applied to the tissue being pulled .

The retractor body 2512A also includes a portable energy source such as a battery 2547 and an illumination source, such as light 2546, to produce illumination. Figure 29 shows a front perspective view of the retractor in Figure 28;

The illuminated soft tissue retractor 2510 can be used to perform a number of different minimally invasive and open surgical procedures. The following examples of thyroid treatment are illustrative and not limiting. In practice, an illuminated soft tissue retractor is used to perform minimally invasive thyroidectomy as described below.

Figure 31 shows an illuminated retractor such as the embodiment described in Figures 25-30 used above in thyroid treatment. Retractor 2512 is inserted into incision I and used to pull tissue T as described in more detail below. This creates a space for the physician to work and allows the surgical device S, such as an electrosurgical device, to be inserted into the surgical area.

The patient is placed in a position to place the back on the floor. Padding the arm on the side of the patient and putting it in. A shoulder roll is placed to stretch the neck and a doom donut is placed to provide head support. A pillow is placed underneath the patient's knee, and a hose that fits into a continuous body at the thigh high is applied. O.R. The head of the table is lifted by about 10 degrees and the foot is lifted by 10 degrees. The patient is then prepared for surgery and draped. A drape is placed, allowing access from the suprasternal notch to the jaw and laterally to the periphery of the sternocleidomastoid muscle.

After covering the curtain, the croid cartilage is positioned by facilitation. A skin marker is used to mark the incision 3-4 cm long by 1 cm below the clowoid cartilage. If the incision is less than 1 cm, the superior pole of the thyroid will be more difficult to incise. The incision consists of a # 15 blade down the broad plinth (platysma) through the skin. Double branch skin hooks are used to pull up and lift the superior skin flap. A Kelly clamp is used to cut the subplatysm plane. The lower broad coronal planes are incised in the same manner. When an adjacent protrusion is caught, an illuminated auditory ray retractor is used to draw the upper flank and illuminate the surgical site. The connective tissue between the strap muscles can be easily identified due to the improved illumination at the surgical site. It is performed via connective tissue with Kelly clamp and electrocautery. The rope muscles are incised in both anterior and posterior. Blunt dissection is used in conjunction with traction counters to collect the muscle of the cord from the thyroid gland. A peanut sponge is used for non-dissection dissection. Similarly, the ends of the illuminated soft tissue retractor can be used for non-dissection peeling, while improving the visualization of adjacent structures by illumination from a TIR waveguide. The blades of the illuminated thyroid retractor are placed under the rope muscles and the adjacent protrusions are pulled laterally to provide the necessary opposite traction.

The adjacent protrusions provide a suitable location for the application of the counter traction without the need for tensile fatigue which must be applied frequently to conventional retractors. At this point, the surgical light above the head does not provide adequate light. The illuminated soft tissue retractor provides the light necessary to sustain treatment in the surgical cavity. Careful non-dissectional dissection continues with contralateral traction to remove attached connective tissue from the thyroid gland. This incision is performed laterally inward into the human body, causing the thyroid to flow from adjacent structures, including the carotid artery.

The incision of the upper pole of the thyroid gland is carried out with a pulled sponge and a traction with an illuminated thyroid retractor. When the connective tissue is incised, the thyroid lobe is pulled down and into the body. A space between the thyroid gland and the cricothyroid muscle is identified. Kelly clamps and a peanut sponge are used to remove the thyroid gland from the knuckle thyroid muscles. The Babcock clamp is placed on the thyroid gland to help position and pull the tension on the lobe top pole. A Kelly clamp is used to identify and incise upper pole vessels. The upper part of the thyroid gland is also identified and then incised. The opposing traction and illumination are maintained as an illuminated thyroid retractor while the upper pole vessels are tied.

The superior pole vessel is bundled and the thyroid lobe is reflected to the inside and the upper part of the body. An illuminated thyroid retractor is laterally displaced to expose the lateral and inwardly directed structures of the thyroid gland. A pinut sponge is used to cut the remaining connective tissue. Mosquito clamps are used to dissect and identify internal parathyroid glands, thyroid blood vessels, and repeated laryngeal nerves. A careful incision is required to avoid repeated injury to the hypoglossal nerve. The connective tissue between the thyroid gland and the airway is incised with a mosquito clamp and a peanut sponge. The incision continues into the human body toward Berry's ligament. Mosquito clamps are used to incise and clamp Berry's ligaments. The sharp incision with the # 15 blade and the rest of the tissue is tied. (The same technique is then performed in the same order on the opposing side). Once the thyroidectomy is complete, a hemostasis is obtained. The rope muscle is re-approximated with an absorbable suture line of 3-0. The skin closes with an absorbable suture line of 5-0. A 5-0 subcuticular suture is used to close the skin. Any suitable op-site dressing is used to treat the wound.

The traction-to-traction technique is a technique used to provide tissue separation and visualization of the recurrent laryngeal nerve and parathyroid glands in minimally invasive thyroid surgery, as described above. These structures are preserved and it is important not to be injured during thyroidectomy surgery. The traction-facing traction technique has been conventionally accomplished using a USA or Army-Navy retractor to pull the cord muscle and the carotid sheath away from the thyroid gland while simultaneously pulling the thyroid gland in opposite directions.

Headlights can be used to view the surgical site. The headlight provides the light of the unidirectional beam aimed at by the physician. When the thyroid is incised, the doctor constantly changes his / her head, neck, and upper body so as to illuminate the light beam into different areas of the incision. Constant repositioning adds stress to physicians, and in some instances doctors may not be able to spot where light is required. Thus, the light retractor described in the text may be used alone or in conjunction with the headlight to illuminate the surgical area.

The illuminated soft tissue retractor 2510 has a retractor blade that is longer and narrower than a conventional thyroid retractor. The tip of the ladder is flared out to increase the surface area for traction and incision. Adjacent lobes can easily fit into the doctor's hand while reducing fatigue. The drop angle of 15 degrees allows the physician to maintain his arms and shoulders in a more neutral position relative to the conventional retractor. Including the TIR waveguide optimizes the visualization of the tissue at the deep surgical site without tiring the headlight and using it.

In an alternative configuration, the retractor assembly 2512 may be formed of a detachable element. The retractor blade 2512B may be interchangeable and may be detached from the retractor body 2512A at the interface 2513. [

While preferred embodiments of the present invention have been shown and described in the text, it will be clear to those skilled in the art that such embodiments are illustrative. Many variations, modifications, and alternatives will occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described in the text may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the claims and their equivalents be covered thereby.

Claims (83)

An illuminated modular surgical retractor for illuminating a surgical area,
Ergonomically designed handle for doctor's hand;
A retractor blade releasably coupled to the handle, the retractor blade adapted to grip tissue and pull the tissue in a traction direction;
A quick release mechanism coupled to the handle and the retractor blade, the quick release mechanism being adapted to engage the handle with the retractor blade; And
An illuminator blade releasably coupled to the handle and disposed adjacent to the retractor blade, the illuminator blade comprising a light input, a light conducting portion, and an optical output;
Lt; / RTI >
The illuminator blade serving as a waveguide for transmitting light from the optical input section to the optical output section via the optical delivery section by total internal reflection,
The light is extracted from the light output portion to illuminate the surgical area,
The retractor blade being releasable from the handle in a direction transverse to the traction direction,
The retractor blade being releasable from the handle without having to separate the fixture blade from the handle,
Wherein said retractor blade is releasable from said handle without the need for optical separation of said illuminator blade from a light source. ≪ Desc / Clms Page number 13 > 2. The surgical instrument of claim 1, wherein the handle has a near end and an end, the handle further comprising a flared area adjacent the near end to facilitate handling by a physician Illuminated modular surgical retractor. 2. The illuminated modular surgical retractor of claim 1, wherein the handle comprises a wavy scalloped region adjacent the distal end of the handle. 7. The illuminated modular surgical retractor of claim 1, wherein the handle comprises a hub disposed adjacent a proximal end of the handle, and the hub is releasably coupled to the handle. . 2. The illuminated modular surgical retractor of claim 1, wherein the handle comprises a textured outer surface. 6. The method of claim 5, wherein the textured surface comprises a plurality of finger gloves arranged to circumferentially surround the handle, the surgeon being adapted to easily handle the handle, Modular surgical retractor. 2. The illuminated modular surgical retractor of claim 1, wherein the handle comprises a substantially cylindrical body. 2. The illuminator of claim 1, wherein the handle comprises a first channel extending between the proximal end and the distal end of the handle and sized to receive a cable for optically coupling the light input of the illuminator blade to the light source Wherein the light source is configured to illuminate the surgical area. 9. The apparatus of claim 8, wherein the handle comprises a second channel extending between the proximal end and the distal end of the handle and sized to receive a suction tube coupling the retractor blade in fluid communication with a vacuum source An illuminated modular surgical retractor that illuminates the surgical area of the operation. 9. The system of claim 8, wherein the handle includes a plurality of cable positioning apertures disposed adjacent a proximal end of the handle, wherein the cable positioning aperture is configured to optically couple the illuminator blade with the light source, Is sized to slidably receive the first channel and communicates with the first channel, and the cable is disposed laterally to the side of the handle. 2. The illuminated modular surgical retractor of claim 1, wherein the retractor blade is pivotally coupled to the handle. 2. The retractor of claim 1, wherein the retractor blade includes a plurality of vacuum channels disposed along the retractor blade, the handle having a second channel extending between the proximal end and the distal end of the handle, Is sized to receive a suction tube that couples said plurality of vacuum channels in fluid communication with a vacuum source. ≪ Desc / Clms Page number 13 > 6. The retractor of claim 1, wherein the retractor blade includes at least one vacuum channel disposed within the retractor blade, the illuminator blade airtightly engaging the retractor blade to prevent vacuum leakage along the seal An illuminated modular surgical retractor that illuminates the surgical area of the operation. 2. The surgical instrument of claim 1, wherein the retractor blade includes one or more channels therein for delivering vacuum, and wherein a cover is disposed over the channel and is in an airtight engagement with the channels. Illuminated modular surgical retractor for illuminating areas. 15. The illuminated modular surgical retractor of claim 14, wherein the cover is slidably engaged with the retractor blade. 15. The illuminated modular surgical retractor of claim 14, wherein the cover is fixedly coupled to the retractor blade. The retractor blade of claim 1, wherein the retractor blade includes an end tip releasably coupled to the distal end of the retractor blade and adapted to grip and hold tissue during traction. Surgical Retractor. 2. The illuminated modular surgical retractor as recited in claim 1, wherein the retractor blade releasably includes an extension blade coupled to a distal end of the retractor blade. 8. The illuminated modular surgical retractor as recited in claim 7, wherein said distal tip comprises a textured surface. 18. The illuminated modular surgical retractor as recited in claim 17, wherein the distal tip is curved upward in the traction direction. 18. The surgical instrument of claim 17, wherein the distal tip comprises a covering disposed over the distal tip, the covering having a textured surface adapted to grip tissue during traction, Illuminated, modular surgical retractor. The apparatus of claim 1, further comprising an alignment feature disposed on the retractor blade or the handle, the alignment feature adapted to linearly align the retractor blade to the handle during engagement between the retractor blade and the handle Wherein the surgical light is illuminated by a light source.  23. The illuminated modular surgical retractor as recited in claim 22, wherein the alignment feature comprises a rail disposed on the retractor blade or the handle. 2. The retractor of claim 1, wherein the retractor blade includes a proximal region and a distal region, the proximal region is disposed in a first plane substantially parallel to the handle, and the second region is transverse to the first plane Wherein the first and second surfaces are in a second plane. 2. The illuminated modular surgical retractor of claim 1, wherein at least a portion of the retractor blade is electrically insulated. The fastener of claim 1, wherein the quick release mechanism comprises an engagement element disposed on either the handle or the retractor blade, and a receptacle on the other of the handle or the retractor blade, And is sized to receive the engagement element. ≪ Desc / Clms Page number 13 > 27. The illuminated modular surgical retractor of claim 26, wherein the engagement element is slidably received in the receptacle. 27. The illuminated modular surgical retractor as recited in claim 26, wherein the engagement element rotatably engages the receptacle. 29. The illuminated modular surgical retractor of claim 28, wherein the engagement element comprises a T-shaped bar rotatably engageable with the receptacle. 28. The illuminated module of claim 26, wherein the engagement element comprises an enlarged head, the receptacle including a flanged portion sized to receive the enlarged head. Surgical Retractors. 27. The quick release mechanism of claim 26, wherein the quick release mechanism comprises an actuator mechanism for moving the engagement element between a retracted position and an advanced position, wherein in the advanced position the engagement element comprises: And wherein the engagement element is biased to return to the traction position. ≪ Desc / Clms Page number 24 > 2. The apparatus of claim 1 wherein the quick release mechanism comprises a detent on either the handle or the retractor blade and an outlet for receiving the detent on another of the handle or the retractor blade Wherein the light source is configured to illuminate the surgical area. 2. The surgical instrument of claim 1, wherein the quick release mechanism further comprises a locking mechanism for locking the quick release mechanism to prevent disengagement of the retractor blade from the handle. Modular surgical retractors. 34. The apparatus of claim 33, wherein the locking mechanism comprises a rotatable cam having a first position and a second position, wherein in the first position, the rotatable cam prevents operation of the quick release mechanism, In a second position, the rotatable cam permits operation of the quick release mechanism to allow the retractor blade to be disengaged from the handle. ≪ RTI ID = 0.0 > Illuminated modular surgical retractor illuminating the surgical area. 2. The apparatus of claim 1, wherein the quick release mechanism comprises a rotatable lever disposed on one of the handle or the retractor blade, the rotatable lever having a first position and a second position, Characterized in that said lever prevents slidable movement between said retractor blade and said handle and in said second position said lever permits a slidable movement between said retractor blade and said handle An illuminated modular surgical retractor. 2. The surgical instrument of claim 1, further comprising a suction tube in fluid communication with the retractor blade, the quick release mechanism including an aperture disposed in the retractor blade to receive the suction tube. Illuminated modular surgical retractor for illuminating areas. 2. The apparatus of claim 1, wherein the retractor blade includes a channel extending from a proximal end of the retractor blade toward an end of the retractor blade, and the illuminator blade is disposed in the channel. Modular surgical retractors. 2. The illumination system of claim 1, wherein the illuminator blade has an active zone and a dead zone, wherein light passes through the active zone by total internal reflection and light does not substantially pass through the dead zone due to total internal reflection An illuminated modular surgical retractor that illuminates the surgical area of the operation. 39. The apparatus of claim 38, wherein the fixture blade has an engagement element in the dead zone, the engagement element retains an air gap between the fixture blade and the active zone of the retractor blade, causing the fixture blade to urge the retractor blade And wherein the positioning of the surgical region is reversed. 2. The light source of claim 1, wherein the light input section includes an active zone and a dead zone, the light passing through the active zone by total internal reflection, and the light not being able to substantially pass through the dead zone An illuminated, modular surgical retractor that illuminates a characteristic surgical area. 41. The illuminated modular surgical retractor of claim 40, wherein the light input comprises a cylindrical proximal end adapted to engage a light source and a rectangular distal end optically coupled to the photoconductive portion. 42. The apparatus of claim 41, further comprising a shield having a collar, wherein the collar is disposed on the cylindrical proximal end such that an air gap is maintained between the collar and the cylindrical apical end. Surgical Retractors. 43. The illuminated modular surgical retractor of claim 42, wherein the shield is disposed over the photoconductive portion. 43. The surgical instrument of claim 42, wherein the shield protects the blade illuminator from damage caused by other surgical instruments in the surgical area, and the shield also shields the surgeon from the flash emitted from the blade illuminator. Illuminated modular surgical retractor for illuminating areas. 43. The illuminated modular surgical retractor of claim 42, wherein the shield includes a tab adapted to releasably couple the blade illuminator to the handle. 2. The apparatus of claim 1, wherein the light output portion comprises a plurality of surface features for extracting light from the blade illuminator and directing the extracted light laterally and / or end- Illuminated modular surgical retractor illuminating the surgical area. 47. The illuminated modular surgical retractor of claim 46, wherein a portion of the surface feature comprises a parallel prism shape having a first facet and a second facet. 2. The illuminated modular surgical retractor of claim 1, wherein the light input section comprises a generally cylindrical input zone transitioning to a generally rectangular neck. 2. The illuminated modular surgical retractor of claim 1, wherein the blade illuminator has a width and a thickness, the width being generally greater than the thickness. 2. The illumination system of claim 1, wherein the light input portion is disposed in a plane substantially parallel to the handle, and the light output portion is in a plane transverse to the plane. Retractor. 2. The system of claim 1, further comprising a light input cable optically and releasably coupled to the light input of the blade illuminator, wherein the light input cable optically couples the light source and the blade illuminator Illuminated modular surgical retractor illuminating the surgical area. 2. The illuminated modular surgical retractor of claim 1, further comprising a vacuum channel for evacuating smoke from the surgical area. 53. The illuminated modular surgical retractor of claim 52, wherein the vacuum channel comprises a plurality of channels coupled to the retractor blade in fluid communication with the vacuum source. 54. The apparatus of claim 53, further comprising a first cover disposed on the channels to form a plenum for discharging the smoke between the channels and the first cover Illuminated modular surgical retractor. 55. The illuminated modular surgical retractor of claim 54, further comprising a second cover disposed on the channels. 57. The illuminated modular surgical retractor as recited in claim 55, wherein said first cover is disposed in one line with said second cover. 57. The illuminated modular surgical retractor as recited in claim 55, wherein said first cover is disposed on top of said second cover. 56. The illuminated modular surgical retractor of claim 55, wherein the joint engages the first cover and the second cover. 56. The illuminated modular surgical retractor of claim 55, wherein the first cover or the second cover is slidable linearly with respect to the channels to adjust the vacuum intensity. 56. The method of claim 55, wherein the first cover includes a plurality of apertures extending through the first cover, and the vacuum strength is adapted to slide the second cover over the first cover to adjust exposure of the aperture. Wherein the second cover is slidably disposed over the first cover so that the second cover can be adjusted by adjusting the second cover. 57. The illuminated modular surgical retractor as recited in claim 55, wherein said retractor blade comprises a long, thin channel, said first and second covers being disposed in said channel. 54. The surgical instrument of claim 53, further comprising: a vacuum hose disposed in the handle, the vacuum hose being associated with the retractor blade to fluidly connect the plurality of channels to the vacuum source Illuminated, modular surgical retractor. 63. The illuminated modular surgical retractor of claim 62, wherein the vacuum hose must be disengaged from the retractor blade prior to disengaging the retractor blade from the handle. The surgical stapler according to claim 1, further comprising a pivot mechanism coupled to the handle, the pivot mechanism allowing adjustment of the angle between the retractor blade and the handle. Retractor. A surgical method for traction of soft tissue comprising:
Providing an illuminator blade coupled to the handle to the handle;
Selecting a retractor blade from a plurality of retractor blades;
Releasably coupling the retractor blade to the handle;
Disposing said retractor blade in a surgical area;
Illuminating the surgical area with light extracted from the light output portion of the illuminator blade, the light being transmitted from the near end of the illuminator blade to the light output portion by total internal reflection;
Tracing the soft tissue in a traction direction with the retractor blade; And
Releasing the retractor blade from the handle in a direction transverse to the traction direction, the retractor blade releasing the retractor blade released from the handle without the need to separate the fixture blade from the handle;
Lt; / RTI >
Wherein the retractor blade is released from the handle without the need to optically decouple the illuminator blade from the light source. 66. The surgical method of claim 65, wherein releasing the retractor blade comprises actuating an actuator mechanism. 66. The method of claim 65, wherein releasing the retractor blade includes releasing the detent mechanism. 66. The surgical method of claim 65, wherein releasing the retractor blade comprises rotating the lever. 66. The method of claim 65, wherein releasing the retractor blade comprises disengaging the retractor blade in a direction toward an end of the retractor blade. 66. The method of claim 65, wherein the cable optically couples the light source with the blade illuminator, and releasing the retractor blade from the handle does not require decoupling the cable from the blade illuminator The method comprising the steps of: 66. The method of claim 65, wherein releasing the retractor blade comprises rotating the retractor blade relative to the handle. 66. The method of claim 65, wherein releasing the retractor blade comprises separating the suction tube from the retractor blade and pulling the suction tube through the handle. . 66. The method of claim 65, wherein engaging the retractor blade with the handle comprises sliding the magnifying head to a receptacle, wherein the magnifying head is disposed on the retractor blade or the handle, Wherein the retractor blade is disposed on another of the retractor blade or the handle. 66. The method of claim 65, further comprising locking the retractor blade and the handle after engagement between the handle and the retractor blade. 66. The surgical method of claim 65, further comprising unlocking the retractor blade from the handle before releasing the retractor blade and the handle. 66. The method of claim 65, further comprising releasably engaging a hub and a proximal end of the handle. 66. The method of claim 65, further comprising pivoting the retractor blade about the handle. 66. The method of claim 65, further comprising draining smoke from the surgical area, wherein the smoke is discharged from the surgical area by applying suction through a plurality of channels in the blade. Surgical methods for. 79. The method of claim 78, further comprising adjusting the suction strength. 80. The method of claim 79, wherein adjusting the suction strength comprises moving the plate over the plurality of channels to control exposure of the channel. 66. The method of claim 65, further comprising engaging or disengaging the distal retractor tip with the retractor blade. 66. The method of claim 65, further comprising applying a cover on the distal end of the retractor blade, the cover having a surface feature adapted to grip tissue. 66. The method of claim 65, wherein the cable is positioned laterally to one side of the handle by positioning the cable in one of a plurality of cable positioning apertures disposed adjacent a proximal end of the handle ≪ / RTI > further comprising the step of:

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